Agent Owned Insurance Group, LLC
PO Box 925
Summerville, SC 29484-0925
ph: 843-261-9677
fax: 843-261-9678
alt: 803-340-0980
aaron
We designed this form to assist you to prepare for the future of your loved ones and secure your financial needs!! Please print the Insurance Needs Survey Form or email to aaron@agentownedinsurance.com , mail to PO Box 925, Summerville, SC 29484 or fax to 843-261-9678 or call 843-261-9677. Thank you!
| 1 - Strongly Agree | 2 - Agree | 3 - Neutral | 4 - Disagree | 5 - Strongly Disagree | Comments |
You need insurance to provide your family with the funds for:
Burial Expenses 1 2 3 4 5
Mortages, Loans, College 1 2 3 4 5
Replacement Income 1 2 3 4 5
401K Rollover 1 2 3 4 5
Fixed Annuity or IRA 1 2 3 4 5
Equity Indexed Annuity 1 2 3 4 5
Affordable Final Expense Insurance 1 2 3 4 5
Long Term Care or Nursing Home Coverage 1 2 3 4 5
An Immediate Annuity with Income Payments 1 2 3 4 5
Creating A Will or Living Will 1 2 3 4 5
Medical Supplies(Wheelchairs, Beds, etc.) 1 2 3 4 5
Cancer Protection Plans 1 2 3 4 5
Disability Income Coverage 1 2 3 4 5
Critical Illness Coverge(Stroke, Heart, etc) 1 2 3 4 5
Major Medical Health Insurance 1 2 3 4 5
Be tax deferred 1 2 3 4 5
Earn a higher interest rate 1 2 3 4 5
Both 1 2 3 4 5
NAME_____________________________________________
Contact Preference(Circle One) phone, email, postal mail
Phone_______________________________________
Email____________________________________________
Address_________________________________________
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City, State ______________________________________
Zip Code_____________________________________
Copyright 2009 Agent Owned Insurance Group, LLC. All rights reserved.
Agent Owned Insurance Group, LLC
PO Box 925
Summerville, SC 29484-0925
ph: 843-261-9677
fax: 843-261-9678
alt: 803-340-0980
aaron